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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe main objective in caring for type 2 diabetes mellitus patients is the prevention of microvascular and potentially macrovascular complications with improved glycemic control along with management of other risk factors [Konig M et al. \u003Cem\u003ECurr Diabetes Rev 2013\u003C\/em\u003E]. Diabetes is associated with both kinds of complications, affecting numerous organs, including the heart, brain, and kidneys [Cade WT. \u003Cem\u003EPhys Ther 2008\u003C\/em\u003E]. This article discusses new ways to diagnose diabetes and identify those at high risk using HbA1C, dysglycemia in acute coronary syndromes, and diabetes and heart failure.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHyperglycemia\/Hypoglycemia\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHyperglycemia\/Hypoglycemia\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAccording to the International Diabetes Federation, the number of people with the disease is increasing in every country. In 2011, diabetes affected 366 million individuals worldwide, and that figure is expected to rise to 552 million by 2030. Over 180 million people with diabetes (50%) are undiagnosed [International Diabetes Federation. IDF Diabetes Atlas: Fifth Edition, 2011. \u003Ca href=\u0022http:\/\/www.idf.org\/diabetesatlas\/5e\/the-global-burden\u0022\u003Ewww.idf.org\/diabetesatlas\/5e\/the-global-burden\u003C\/a\u003E].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe main objective in caring for type 2 diabetes mellitus (T2DM) patients is the prevention of microvascular and potentially macrovascular complications with improved glycemic control along with management of other risk factors [Konig M et al. \u003Cem\u003ECurr Diabetes Rev\u003C\/em\u003E 2013]. Diabetes is associated with both kinds of complications, affecting numerous organs, including the heart, brain, and kidneys [Cade WT. \u003Cem\u003EPhys Ther\u003C\/em\u003E 2008]. While improving glycemic control has been shown to reduce microvascular complications, the impact on macrovacular complications has been less clearly established.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EGlycated hemoglobin (HbA1C) is emerging as an important tool for formally diagnosing diabetes in the United States [American Diabetes Association. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2010]. Screening for diabetes previously performed with standard fasting blood glucose or glucose challenge testing may now be done with HbA1C [Preiss D et al. \u003Cem\u003EDiabet Med\u003C\/em\u003E 2011]. Naveed Sattar, MD, University of Glasgow, Glasgow, Scotland, United Kingdom, discussed new ways to diagnose diabetes and identify those at high risk using HbA1C.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe adoption of HbA1C into diagnostic criteria will facilitate diabetic screening and may help refine assessment of cardiovascular risk (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Sattar N, Preiss D. \u003Cem\u003EDiabetologia\u003C\/em\u003E 2012]. As a diabetes risk assessment and screening option, it requires no fasting and can dovetail with existing vascular screening. This makes it a very attractive way to greatly improve early detection and management of individuals at high risk of cardiovascular disease (CVD) and\/or diabetes [Preiss D et al. \u003Cem\u003EDiabet Med\u003C\/em\u003E 2011]. Based on such evidence, HbA1C has now been accepted into the European Society of Cardiology\/European Association for the Study of Diabetes guidelines for the diagnosis of diabetes.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/15\/32\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022HbA1C as Diagnostic Criteria Will Facilitate Combined CV and Diabetic Screenings\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1053983280\u0022 data-figure-caption=\u0022HbA1C as Diagnostic Criteria Will Facilitate Combined CV and Diabetic Screenings\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/15\/32\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/15\/32\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/15\/32\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13596\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EHbA1C as Diagnostic Criteria Will Facilitate Combined CV and Diabetic Screenings\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ECV=cardiovascular; FPG=fasting plasma glucose; IGT=impaired glucose tolerance; OGTT=oral glucose tolerance test.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EAdapted from Sattar N, Preiss D. \u003Cem\u003EDiabetologia\u003C\/em\u003E 2012.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EAs the interplay between CV risk and diabetes risk becomes clearer the case for combined diabetes\/other CV risk factor screening (generally using HbA1C and nonfasting lipids) has now gained support [Sattar N. \u003Cem\u003EDiabetologia\u003C\/em\u003E 2013]. Prof. Sattar discussed this and other new paradigms in play, including those that obviate conventional wisdom.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EA meta-analysis challenged the belief that T2DM is a myocardial infarction risk equivalent [Sarwar N et al. \u003Cem\u003ELancet\u003C\/em\u003E 2010]. Rather, data showed that diabetes confers about a 2-fold excess risk for a wide range of vascular outcomes.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EMore recent data suggest that the duration of T2DM is associated with CVD; both early and late onset of diabetes are associated with increased risk; however, only early onset (associated with a duration \u0026gt;10 years) seems to portend risk equivalent to coronary heart disease [Wannamethee SG et al. \u003Cem\u003EArch Intern Med\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EWhereas blood glucose was once considered a linear risk factor for CVD with a dose-response relationship [Levitan EB et al. \u003Cem\u003EArch Intern Med\u003C\/em\u003E 2004], Sarwar et al. [\u003Cem\u003ELancet\u003C\/em\u003E 2010] report that fasting blood glucose has a J-shaped relationship with vascular risk, with little if any risk at concentrations between 3.90 and 5.59 mmol\/L, and risk escalating appreciably around current diagnostic cutoffs (ie, 7 mmol\/L).\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EThe ADVANCE trial investigated the relationship between HbA1C and the risk of vascular complications and death in patients with T2DM [Zoungas S et al. \u003Cem\u003EDiabetologia\u003C\/em\u003E 2012]. The trial found that reducing HbA1C levels was associated with lower risks of microvascular events down to a threshold of 6.5%, and macrovascular events and death down to a threshold of 7.0% (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/15\/32\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022The Association of HbA1C With Risk in Diabetes\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1053983280\u0022 data-figure-caption=\u0022The Association of HbA1C With Risk in Diabetes\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/15\/32\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/15\/32\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/15\/32\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13598\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-12\u0022 class=\u0022first-child\u0022\u003EThe Association of HbA1C With Risk in Diabetes\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EAdapted from Zoungas S et al. Association of HbA1c levels with vascular complications and death in patients with type 2 diabetes: evidence of glycaemic thresholds. \u003Cem\u003EDiabetologia\u003C\/em\u003E 2012;55(3):636\u2013643.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EUPDATE ON MANAGING DYSGLYCEMIA IN ACUTE CORONARY SYNDROMES\u003C\/h2\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EAccording to Anna Norhammer, MD, PhD, Karolinska University Hospital, Stockholm, Sweden, managing dysglycemia in the coronary care unit has evolved with insight from trials of glycemic control in the intensive care unit setting. The first DIGAMI trial, published in 1995, showed a clear mortality reduction with glucose control during and after the acute phase of a myocardial infarction, aiming at blood glucose levels between 7 to 10 mmol\/L (plasma 7.7 to 11 mmol\/L) during the acute phase. Since then trials from the intensive ward have reported conflicting results when it comes to lowering glucose during hospitalization [Malmberg K, Ryden L. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 1995].\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EIn 2001, van den Berghe et al. [\u003Cem\u003EN Engl J Med\u003C\/em\u003E] found that intensive insulin therapy to maintain blood glucose at or below 110 mg\/dL reduced both morbidity and mortality among critically ill patients in the surgical intensive care unit (ICU). In 2009, Finfer et al. [\u003Cem\u003EN Engl J Med\u003C\/em\u003E] demonstrated that intensive glucose control increased mortality among adults in the ICU, with a more lenient blood glucose target of \u2264180 mg\/dL resulting in lower mortality compared with a more intense target of 81 to 108 mg\/dL. These data demonstrate a consistent pattern across care settings of increased CV risk associated with both hyperglycemia as well as hypoglycema.\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EThis year\u0027s European Society of Cardiology Guidelines on Diabetes, Pre-diabetes, and Cardiovascular Diseases (developed in collaboration with the European Association for the Study of Diabetes) recommend that insulin-based glycemic control should be considered in acute coronary syndrome (ACS) patients with significant hyperglycemia of \u0026gt;180 mg\/dL (\u0026gt;10 mmol\/L), with the target adapted in the presence of comorbidities [Ryd\u00e9n L et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2013]. In addition, glycemic control that may be accomplished by different glucose-lowering agents should be considered in DM and ACS.\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003ERemaining questions, said Prof. Norhammer, include the role and optimal level of glycemic control for the outcome in ACS patients; and whether it is possible to reduce final infarct size by means of very early glucose-insulin-potassium administration after symptoms of myocardial infarction. Prof. Norhammar concluded that we should keep measuring glucose in the cardiac care unit and suggested that aiming at glucose levels between 7.8 to \u0026lt;11 mmol\/L should be safe while the risk for hypoglycemia probably will increase if targeting values lower than 7 mmol\/L. She also pointed out that a large proportion of patients will have previously unknown diabetes and impaired glucose intolerance, about 60% of myocardial infarction patients. This is only determined by performing an oral glucose tolerance test before discharge [Norhammer A et al. \u003Cem\u003ELancet\u003C\/em\u003E 2002].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EDIABETES AND HEART FAILURE: WHAT ARE THE MANAGEMENT OPTIONS?\u003C\/h2\u003E\n         \u003Cp id=\u0022p-17\u0022\u003ESome 5.7 million people in the United States have heart failure (HF) [Roger VL et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2012]. HF causes \u0026gt;55,000 deaths each year [Kochanek KD et al. \u003Cem\u003ENatl Vital Stat Rep\u003C\/em\u003E 2011], with significant associated costs related to healthcare services, medications, and lost productivity [Heidenriech PA et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2011]. David Aguilar, MD, Baylor College of Medicine, Houston, Texas, USA, discussed the management options for DM and HF.\u003C\/p\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EAccording to Dr. Aguilar, management of diabetes in patients with HF is generally is similar to those without HF, but there are diabetes-specific issues. These include the appropriate glycemic targets in patients with HF, and the appropriate options for hyperglycemic therapy.\u003C\/p\u003E\n         \u003Cp\u003ERecommendations for glycemic control from the American Diabetes Association [\u003Cem\u003EDiabetes Care\u003C\/em\u003E 2013] call for:\n\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n                  \u003Cp id=\u0022p-20\u0022\u003EHbA1C goal below or around 7%, which is considered reasonable due to microvascular benefits and potential long-term macrovascular benefits if glucose lowering regimen implemented soon after DM diagnosis\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n                  \u003Cp id=\u0022p-21\u0022\u003EMore stringent HbA1C goals (\u0026lt;6.5%) for selected patients (eg, those with short diabetes duration, less risk of hypoglycemia, long life expectancy, and no significant CVD)\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n                  \u003Cp id=\u0022p-22\u0022\u003ELess stringent HbA1C goals (\u0026lt;8%) for those with advanced microvascular or macrovascular complications, extensive comorbid conditions, or a history of hypoglycemia or difficult to treat, longstanding DM\u003C\/p\u003E\n               \u003C\/li\u003E\u003C\/ul\u003E\u003Cp\u003E\n         \u003C\/p\u003E\n         \u003Cp id=\u0022p-23\u0022\u003EAccording to Dr. Aguilar, optimal hyperglycemic therapy in HF patients is not clear. He noted that metformin can be used with caution, and that prospective outcome data are needed for other agents, including glucagon-like peptide-1 agonists and dipeptidyl peptidase-4 inhibitors given unexpected results from the SAVOR-TIMI 53 trial in high-risk CV patients (see article on page 17).\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/15\/32.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nznnb1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznnb1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}